Extremis (2016) Movie Script

[EKG machine beeping]
[Dr. Zitter] How are you doing?
I know that's a stupid question.
I don't think you're doing
very well right now.
But can you write for me
so that we can talk a little bit,
or do you not have the energy right now?
Do you wanna write?
[patient groans]
[Dr. Zitter] Okay, I have a better idea.
What's the first letter?
-[doctor] T.
-[Dr. Zitter] T.
[patient groans]
[Dr. Zitter] Okay.
Start one more time. Start one more time.
I know, I'm sorry.
I'm sorry. I'm sorry.
Can we try with these letters, okay?
N? No.
Say it again.
Is it about the tube?
Is this about the breathing tube?
Do you want the breathing tube out?
Do you want me to take it away?
You want it out?
What if you die if I take it out?
This is Violeta calling
from intensive care
at Highland Hospital in the ICU.
14:19 was the time of death, yes.
Sixty-six-year-old gentleman,
history of HIV.
Past medical history of dementia, COPD.
Probably substance abuse,
cocaine and currently methadone.
[EKG machine flatlining]
[Dr. Zitter] Who is this?
Call the crash cart in.
-[Dr. Zitter] It's okay.
-[woman crying]
-[doctor 1] Let's get an EKG--
-[doctor 2] EKG.
-[indistinct chatter]
-[woman gasping]
[doctor] I just think
we should have the conversation
about, "What did he really want?"
'Cause if he didn't want even antibiotics,
now we're putting a ventric in and then
we're gonna obligate him to a shunt
if he makes it out of this.
[nurse] Best case scenario
for the guy is probably grim,
but he's also 30 years old
and we don't know how much
of his decision-making
is attributable to medical illness,
it's impossible to state.
So, I'm uncomfortable with
making the decision now to let him die.
[Dr. Zitter] Here's the reality.
We're all gonna die, everyone standing
in this room is gonna die one day
and it's good to have
a little bit of a say in how.
[EKG machine beeping]
I know, I know, the straps.
I know, sweetheart.
It's frustrating, I know. [softly] I know.
[Gordon] It's all good.
Okay, okay, okay. I know.
The reason the straps are on
is so that you don't pull anything out.
It's to protect you.
I know it's hard to communicate, huh?
You want me to... you want me...
you want me to help you get your legs out?
I... I can't, you know that.
You wanna get up?
I can't get you up.
Okay, if that's what you're trying
to tell me, I understand.
Okay? I know you want me to get you out.
Okay. All right.
I would say that if her muscle strength
doesn't improve...
If her muscle strength improves,
then, you know,
-that eliminates a lot of problems for us.
-All right.
But if this represents a decline
in the overall disease state...
Or... or just even stays the same.
Stays the same.
Then she will require some sort of machine
to help her breathe.
[Gordon stutters] Is there any
other option,
or is it really this ventilator system
or that, are those the...
are those the only two options?
[Dr. Bhargava] The tracheostomy is...
is really the main form of...
of intervention we could offer,
if she were willing to accept,
you know, being attached to a machine.
Is that something that she
would want for herself,
that she would be open to?
Is it just to...
just to kinda keep her in limbo?
Is it... I mean, that's...
that's pretty much it?
You're right, it's a form of limbo.
[machine beeping]
[Gordon] I need ya
to help me get beyond this.
I have to be right for her.
I'll be right for you.
[indistinct chatter]
So she showed up at the hospital
-in the car and then--
-[doctor 1] No. She was in the car.
They were trying to bring her
to the hospital and she arrested.
Sixteen to 26 minutes from arrest
to return of circulation.
[Dr. Zitter] Sixteen to 26 minutes
of down time.
-[doctor 2] Mmm-hmm.
-[doctor 1] Mmm-hmm.
Was that the family doing CPR in the car?
-[doctor 1] Yes.
You woke up in the morning and said,
"Mom, I'm taking you to hospital."
[Tama] She didn't want me
to call the ambulance,
'cause she... thought about that $2,000.
-You know, so...
-[Dr. Zitter] Oh...
she kinda was like--
[Dr. Zitter] So she finally said,
"I'm going in."
-Not in the best financial situation.
-Oh, sorry.
Yeah, so then she jumps in
my husband's car, we're driving off,
and she said, "Guys, hurry up,"
and then she went... [gags]
And then we had to pull her
out the car and start to do
the resuscitation with the CPR.
[Dr. Zitter] That must
have been terrifying.
Oh, it was beyond terrifying.
I must say, that's impressive,
and your mom's lucky.
And now where are we?
Tell me what you understand.
-[Tama] They want big responses.
-[Dr. Zitter] Yep.
[Tama] I'm checking for
any response that I can get.
When I first came in here,
I could touch her hand,
I could do anything,
she wasn't gonna open her eyes.
-Okay, now I come in, I touch her hand...
her eyes went wide open.
Selena? Can you squeeze my hand?
Squeeze my hand.
Squeeze my hand, honey.
Would I like to see her
really looking at me
and kind of following commands?
-[Tama] Yes. Mmm-hmm.
-Yes, I would.
Am I concerned a little bit still
that maybe we won't get
a whole lot more? I am.
To me, the whole situation is miraculous
in and of itself
-So I'm looking for another miracle.
[Dr. Zitter] You know, this is clearly
a loving daughter who will do anything
for her mother, and she's really wrestling
and struggling,
and sometimes it's just too much
for one person to make
a decision like this
-on her own.
-[brother 1] Yeah.
I think you're very sensitive uncles,
-and I think she's lucky.
[brother 2] That's all she has,
is her mother. She's an only child.
[Dr. Zitter] I know.
So it's really, really difficult.
[brother 1] Is there any definitive test
-that will tell you that absolutely,
-[Dr. Zitter] Mmm-hmm.
positively, there is no way
for her to recover under any circumstance?
[Dr. Zitter] She won't wake up from this
in a meaningful way, and I don't know
if that's been clearly stated to you,
if you've heard that.
[brother 1] That's my first time
hearing that.
[Dr. Zitter] Every day,
people with very poor
neurologic prognoses are attached
permanently to machines,
and, unfortunately, it's very hard,
emotionally, for us physicians
when we feel
that we're taking a body and we're just...
we're keeping it alive
when it's not really the person.
[brother 3] But God have proven to me,
miracles are miracles,
and we askin' him for one.
[softly] Okay.
If I had to make the decision for myself,
take me off and if I breathe on my own,
then that's fine, that's God's will.
If I don't breathe on my own, fine,
-then that's God's will.
[brother 4] You know,
'cause I believe in prayer...
but I believe in nature
taking its course, too.
It's tough. It's tough.
I would hate not to do the trache...
[voice breaking] because that's my...
my sister.
But I--
Mmm-mmm. It's too much for me.
[Dr. Zitter, softly] I understand.
I wanna try everything I can.
[sobbing] I just wanna try whatever,
it doesn't make any difference.
[Dr. Zitter] Well, there are very few
things that you can be 100% certain about.
And you risk hurting people
if you're wrong.
My concern is if we continue
to draw it out
-and we continue to do
more and more things to her,
-we're gonna cause more suffering
without likely benefit.
[Dr. Zitter] When I was a young attending,
I had been asked to go put
a large catheter in someone's neck.
She was dying.
And I went into lifesaving mode.
Right before we were getting ready,
I look up and I see
this nurse in the doorway,
and she looked at me,
locking eyes with me and said,
"Call the police.
They're torturing a patient in the ICU."
My heart dropped into my stomach,
and I realized, "Oh, my gosh, she's right.
What I'm doing right now
is not gonna help her.
It's not gonna get rid
of this disease that's killing her."
And I don't wanna do that anymore.
-Living homeless, debilitated,
-[Dr. Bhargava] Mmm-hmm.
-failure to thrive--
He's been institutionalized
for a long time now.
We're just keeping a close eye on you
-to make sure you're feelin' all right.
-[patient] Okay.
[Dr. Zitter] Do you have any
family members or anybody
that is part of your family?
No, that I know... [stutters]
[Dr. Zitter] Oh, I'm sorry?
Not that I know of.
Mmm. Well, we'll help
take care of you then.
[patient] Okay.
If we're gonna treat, the treatment
is the ventriculostomy.
-And what would--
-So if you guys don't agree with that
and if you tell me, "Nope, this guy
would want everything done.
He'd want to live, even if he was
vegetative on a ventilator for his life
with a feeding tube," then the treatment
is to put the ventric in.
I don't feel that he is able
to make those decisions,
and I don't feel that we have someone
who can really make them for him.
We don't really know his prognosis.
We don't know if he ever had capacity
for decision making,
so the ethics of this are murky.
Do you like to make
your own medical decisions,
or do you like the doctors
to make the decisions for you?
If we don't get clear, we're not
gonna give him a chance to opt out,
and we're just gonna do what we do
with all of our patients,
which is just plug them in
and let them die on machine.
How would you feel if you...
were not getting better
on a breathing machine?
Then I don't wanna be
on a breathing machine.
-I don't wanna suffer...
with that machine.
I mean, it's his decision,
but he know as well as I know...
I don't wanna see him go,
you know, 'cause I haven't
lost a parent yet,
you know, so I wouldn't know how it feels.
You know, so...
We're wondering if maybe this is the point
where we kind of need to stop,
decide, and maybe have--
Put the tube in, kinda put you to sleep
and have the machine help breathe for you.
[muffled] How do you make that choice?
[Dr. Zitter] It's a-- It's some--
For some people it's an easy choice,
and for some people it's not.
-I'm 38.
-I know you're 38.
-A new grandma.
-I know.
I don't wanna give my life away yet.
[Dr. Zitter] I know.
[EKG machine beeping]
[indistinct chatter]
[machine beeping]
[Gordon] You look better today,
you know that?
You look better. You look like you got
a little bit of a fight in you today.
Good. So yeah, that's right.
I'll make you laugh
as many times as I can.
That's the deal.
All good. All good.
[Gordon whispering] Her...
organs are failing.
Right now, the only thing
that's functioning is that ventilator.
It's keeping her--
'Cause she's got saliva,
she can choke at any time.
She's been throwing up.
So that's all part of it, her muscles
in her lungs are stopping.
[Dr. Zitter] Hey, Donna?
Um, we're gonna just step out.
I'm gonna go talk to your family
for a little bit...
and then we're gonna come back
and talk with you, if you're up for it.
[Dr. Zitter] Okay.
[clicks tongue]
Things that're happening in her body
right now are all the kinds of things
that you would expect with end-stage
myotonic dystrophy.
And we are very concerned
that... that we may not be able
to get her breathing on her own again.
And what that means,
looking forward, is...
attachment to a breathing machine...
in what's called a ventilator facility.
The other approach is to say we're gonna
take her off the breathing machine
and hope that she lives
for a long period of time.
It probably wouldn't be,
I'm gonna guess more than a day or two.
Maybe, you know, I've been surprised,
sometimes it's longer...
and really focus on her comfort
and her calmness,
and her being with her family
and let her pass naturally.
[sniffs] Knowing at some point
you gotta get to that reality,
you know, but you can always put it off,
and now it's here.
I can't tell if she is alert enough
to have this conversation.
When I talked to her
this morning a little bit,
I didn't feel that she...
was really understanding.
[stutters] And that's--
At that point, if that's the way it is,
and if things don't... if she doesn't
perk up and really become herself,
that's when surrogate people have to
step in and make those choices.
[voice breaking] I wanna
make sure that she knows that--
that we've explored all the options.
I told her I'd never let the doctors stop.
I would never let 'em stop,
but when I told 'em to stop,
she had to trust me.
[Dr. Bhargava] And I'm with you.
I don't want her to suffer
or have anything prolonged or painful.
I just want them to make a decision
with the best information available.
And I feel that as of right now,
as of today,
we haven't had, you know,
an expert in her disorder
weigh in on what her prognosis might be.
-My biggest-- But I was saying--
-My biggest fear is telling a family
that there's zero hope
when maybe there is.
I sat with that family
for an hour and a half.
-And I pulled
every little bit of information about her
-and I found
that she'd had conversations
with her brother
that she had initiated several times
-about not wanting to be on a machine,
not wanting to be kept alive on machines.
Part of me is, like, death is so final
that if we sort of...
-I know.
-If we make the decision
not to go down that route...
I know, I know.
-This is--
And frankly, we're not even making
the decision, they are,
-but it is...
-Well, that's what I'm trying to do,
-guided by what we say. So...
-I'm trying to put it on-- I just--
I don't know. [stuttering]
This is a conundrum for me, too.
[indistinct chatter on PA]
Hi, Mama. Mama?
Mama, I know you're in there. Mama?
[brother 1] Selena.
[brother 2] Hey, sis.
Hey, sis.
You got your brothers here with you.
We're here.
Selena, this is what I'm seeing.
That's the first time she's jumpin'.
[brother 2] I know you trying
to say something, huh?
[brother 3] Yeah, that's all right.
[brother 2] You trying to say somethin',
ain't you?
[brother 3] Yes, Lord.
Come on now, y'all, look at her.
She opened her eyes and move 'em.
-[brother 3] Yes, God.
-Hey, sis.
-[brother 3] We love you, Selena.
-[brother 2] Yes, we do.
[brother 3] We not gonna leave you
by yourself.
[brother 2] We got ya, baby girl.
[brother 4] We just ask
that you touch her, Father God.
You know the doctors say one thing,
Father God,
but we know that you
the doctor of doctors, Father God,
-and the Lord of Lords, Father God.
-[brother 3] In Jesus' name.
[brother 4] In Jesus' name,
we pray this prayer. Amen.
[brothers] Amen.
[Tama] You know, even though
my mom may be in this situation,
it would feel like murder
to pull her life support.
That's what it would feel like to me.
We're gonna support you
through this. This is
-very painful for you and your family.
And we're gonna, you know...
We're all, I mean,
everyone hopes for a miracle,
I'm hoping for a miracle.
I feel like, maybe as a doctor,
being as smart and being as knowledgeable
and being in-- inside of medical journals,
you know, it... it can dwindle
the optimism a little bit.
I'm just trying to help you make
a decision that's right for your mom,
-and that's why I want you to be able
to think through this
as clearly as you can,
just thinking about what would my mom
have said if the doctors were all saying,
"We don't think she'll wake up."
My mom already made her decision,
and that's how come
her heart is still beating.
She can go at any time,
but she knows to stay here
because she loves me.
-If I were to pull that life support
-there would be no me.
[Gordon] Is that how?
[Dr. Bhargava] How long?
Okay, how long...
That that tube is gonna stay in.
I wish I could tell, ma'am.
I can't tell because, right now,
you are breathing independently...
but the machine is providing you
some help right now.
I think the hard part here is just...
we don't know how her body is gonna go.
If this-- We could say for sure
you can spend two months
with a trache and a feeding tube
and then you'll get better,
then most people would probably say,
"Sure, sign me up."
-But if it's,
"I'm gonna be going to this next step
and I have no idea
-whether I'm ever gonna get off of it,"
-I know.
-that's a harder decision to make.
-[grunts softly]
[Gordon] We know you wanna get out
of these straps, right, sweetheart?
We can all tell you've been strugglin'.
So now we wanted to talk about
where do we go from here?
What do you wanna do? Okay?
If... if you can breathe on your own,
they can take the tubes out.
But if, for some reason,
you can't breathe...
then our options are do the trache...
down into your throat...
and that would hook you up to a machine.
And we don't know if that's what you want.
No? You don't want
a feeding tube and the...
and the tracheotomy?
No matter what.
[Gordon whispering] You did
the right thing, okay?
I'm gonna do the right thing.
Just trust me.
-Do you trust me?
I trust you, okay?
I'll take care of her.
You know that. That's my promise, right?
I got her.
You don't worry about her.
That's one thing you don't worry about.
Okay? I got her.
[indistinct singing]
And I'm so sorry that you're gonna be...
[daughter sobbing] Don't. You have nothing
to be sorry about, Mom. Stop.
You can't--
You don't make these decisions,
things happen. It's okay.
[patient sobs] No...
Things happen.
Everybody loves you so much.
You got so much love,
so much prayers, Mom.
Keep fighting. Keep doin' it.
Keep doin' what you doin'.
-[weakly] Tell everybody...
Tell everybody... calm down.
[daughter chuckles] "Tell everybody
to calm down."
[piano music playing]